Patterns of delivery of radiation therapy in an inner-city population of head and neck cancer patients: an analysis of compliance and end results.

A retrospective analysis of survival rate of patients treated for head and neck cancers in a radiation oncology department at an innercity hospital (UMDNJ, Newark, NJ) was performed. Eligible patients received either postoperative or definitive radiation therapy and had no distant metastases. The records of patients treated from 1984-1989 were screened and 78 met the above criteria. Total dose of radiation, fraction size, number of fractions given, and overall duration of treatment were determined. Tumor registry data was used to evaluate patient status. Two patients who died prior to completing radiation treatments were excluded and seven patients were lost to follow up. Therefore, the outcomes and treatments of 69 patients were analyzed. There were two categories of noncompliant patients, those whose treatment duration was in excess of 20% of the prescription, and those whose treatments were discontinued against medical advice. The overall five year survival of the compliant group was 38%, and 12% for the noncompliant group (p < 0.05). The mean survival time for the compliant group was 24.2 months and 12.6 months for the noncompliant group (p < 0.05). Forty-seven per cent of the patients were compliant. Compliant rates for men and women were 46% and 48%, respectively. African-Americans, who made up 71% of the patients analyzed, had a compliance rate of 45%. Caucasians, who made up 22%, had a compliance rate of 47%. The stage at presentation, and therefore prognosis, did not alter compliance rates. Sixty-nine per cent of the patients analyzed had stage III or stage IV disease. This patient group had a compliance rate of 48%, which did not statistically differ from the earlier stage patient group which had a compliance rate of 54%. The length of patient survival from head and neck cancer is related to compliance to radiation treatment. Compliance appears to be directly related to better overall survival and mean survival time. Compliance to treatment does not seem to depend on patient sex, race, or prognosis.